FACILITY ACCESS AUTHORIZATION REQUEST

Form Instructions

1. Enter the name of the individual requesting access authorization
2. Enter the PSU-ID (employees) or Driver's License number (non-employees), as applicable
3. Enter the phone number of the Requestor, including area code
4. Enter the requestors' email address
5. Enter the requestors' college, campus, department (employee) or company name (non-employee)
6. Specify the area(s) where the requestor needs access, providing details such as building name(s), floor(s), room number(s) and/or other defining details
7. Provide clear details specifying WHY the requestor requires access to said locations. Attach explanatory details if needed
8. Select the start date of access
9. If temporary request, select the end date of access. If permanent request, leave this field blank
10. Enter the hours of access (i.e., 8:00 am - 5:00 p.m.)
11. Check all days of the week on which access is required
12. The requestor must provide either a hand-written signature or provide their digital ID
13. Select the date access is issued
14. This field is only completed when access is removed
15. Enter the name of the requestors' supervisor (employee) or sponsor (non-employee)
16. The Supervisor/Sponsor must provide either a hand-written signature or their digital ID
17. Enter the name of the Access Coordinator granting access
18. The Access Coordinator must provide either a hand-written signature or provide their digital ID
19. The Access Coordinator checks the Key(s) box if issuing keys and completed the Key Issuance Log
20. The Access Coordinator checks the Electronic Access box if issuing electronic access
21. The Access Coordinator records any device numbers